tbuckley/cabot-search huggingface dataset:
Dyslipidemia and cardiovascular disease among childhood cancer survivors: a St. Jude Lifetime Cohort report
Authors: Jason F Goldberg, Geehong Hyun, Kirsten K Ness, Stephanie B Dixon, Jeffrey A Towbin, Isaac B Rhea, Matthew J Ehrhardt, Deo Kumar Srivastava, Daniel A Mulrooney, Melissa M Hudson, Leslie L Robison, John L Jefferies, Anand Rohatgi, Gregory T Armstrong
Journal: JNCI Journal of the National Cancer Institute (2023)

Abstract Background Childhood cancer survivors have increased risk of dyslipidemia and atherosclerotic cardiovascular disease (CVD). The aim of this study was to evaluate the prevalence and associated cardiovascular risks of specific lipid abnormalities among childhood cancer survivors. Methods Comprehensive lipid panel measurements were obtained from 4115 5-year survivors, with 3406 (mean age at evaluation = 35.2 years, SD = 10.4 years) not having previous dyslipidemia diagnosis, as well as 624 age, sex, and race and ethnicity matched community controls. Results Previously undiagnosed dyslipidemia with abnormal low-density lipoprotein (LDL) cholesterol (&amp;gt;160 mg/dL), non–high density lipoprotein (HDL) cholesterol (&amp;gt;190 mg/dL), HDL cholesterol (&amp;lt;40 mg/dL for men, &amp;lt;50 mg/dL for women), and triglycerides (&amp;gt;150 mg/dL) were identified in 4%, 6%, 30%, and 17%, respectively. Survivors without previous dyslipidemia diagnosis had higher LDL cholesterol and non-HDL cholesterol and lower HDL cholesterol than community controls. Cranial radiotherapy (relative risk [RR] = 2.2, 95% confidence interval [CI] = 1.6 to 3.0 for non-HDL cholesterol) and total body irradiation for hematopoietic cell transplantation (RR = 6.7, 95% CI = 3.5 to 13.0 for non-HDL cholesterol; RR = 9.9, 95% CI = 6.0 to 16.3 for triglycerides) were associated with greater risk of dyslipidemia. Diagnoses of low HDL cholesterol (hazard ratio [HR] = 2.9, 95% CI = 1.8 to 4.7) and elevated triglycerides (HR = 3.1, 95% CI = 1.9 to 5.1) were associated with increased risk for myocardial infarction, and diagnoses of high LDL cholesterol (HR = 2.2, 95% CI = 1.3 to 3.7), high non-HDL cholesterol (HR = 2.2, 95% CI = 1.3 to 3.7), low HDL cholesterol (HR = 3.9, 95% CI = 2.8 to 5.4), and elevated triglycerides (HR = 3.8, 95% CI = 2.7 to 5.5) were associated with increased risk for cardiomyopathy. Conclusions Previously undiagnosed dyslipidemia among childhood cancer survivors was associated with increased risk for myocardial infarction and cardiomyopathy. Comprehensive dyslipidemia evaluation and treatment are needed to reduce cardiovascular morbidity in this population.
Effects of Semaglutide on Symptoms, Function, and Quality of Life in Patients With Heart Failure With Preserved Ejection Fraction and Obesity: A Prespecified Analysis of the STEP-HFpEF Trial
Authors: Mikhail N. Kosiborod, Subodh Verma, Barry A. Borlaug, Javed Butler, Melanie J. Davies, Thomas Jon Jensen, Søren Rasmussen, Peter Erlang Marstrand, Mark C. Petrie, Sanjiv J. Shah, Hiroshi Ito, Morten Schou, Vojtěch Melenovský, Walter Abhayaratna, Dalane W. Kitzman
Journal: Circulation (2023)

Patients with heart failure (HF) with preserved ejection fraction (HFpEF) and obesity experience a high burden of symptoms and functional impairment, and a poor quality of life. In the STEP-HFpEF trial (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity), once-weekly semaglutide 2.4 mg improved symptoms, physical limitations, and exercise function, and reduced inflammation and body weight. This prespecified analysis investigated the effects of semaglutide on the primary and confirmatory secondary end points across the range of the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores at baseline and on all key summary and individual KCCQ domains.
Direct Oral Anticoagulants for Stroke Prevention in Patients With Device-Detected Atrial Fibrillation: A Study-Level Meta-Analysis of the NOAH-AFNET 6 and ARTESiA Trials
Authors: William F. McIntyre, Alexander P. Benz, Nina Becher, Jeffrey S. Healey, Christopher B. Granger, Lena Rivard, A. John Camm, Andreas Goette, Antonia Zapf, Marco Alings, Stuart J. Connolly, Paulus Kirchhof, Renato D. Lopes
Journal: Circulation (2023)

BACKGROUND: Device-detected atrial fibrillation (also known as subclinical atrial fibrillation or atrial high-rate episodes) is a common finding in patients with an implanted cardiac rhythm device and is associated with an increased risk of ischemic stroke. Whether oral anticoagulation is effective and safe in this patient population is unclear. METHODS: We performed a systematic review of MEDLINE and Embase for randomized trials comparing oral anticoagulation with antiplatelet or no antithrombotic therapy in adults with device-detected atrial fibrillation recorded by a pacemaker, implantable cardioverter defibrillator, cardiac resynchronization therapy device, or implanted cardiac monitor. We used random-effects models for meta-analysis and rated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). The review was preregistered (PROSPERO CRD42023463212). RESULTS: From 785 citations, we identified 2 randomized trials with relevant clinical outcome data: NOAH-AFNET 6 (Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes; 2536 participants) evaluated edoxaban, and ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; 4012 participants) evaluated apixaban. Meta-analysis demonstrated that oral anticoagulation with these agents reduced ischemic stroke (relative risk [RR], 0.68 [95% CI, 0.50–0.92]; high-quality evidence). The results from the 2 trials were consistent (I 2 statistic for heterogeneity=0%). Oral anticoagulation also reduced a composite of cardiovascular death, all-cause stroke, peripheral arterial embolism, myocardial infarction, or pulmonary embolism (RR, 0.85 [95% CI, 0.73–0.99]; I 2 =0%; moderate-quality evidence). There was no reduction in cardiovascular death (RR, 0.95 [95% CI, 0.76–1.17]; I 2 =0%; moderate-quality evidence) or all-cause mortality (RR, 1.08 [95% CI, 0.96–1.21]; I 2 =0%; moderate-quality evidence). Oral anticoagulation increased major bleeding (RR, 1.62 [95% CI, 1.05–2.50]; I²=61%; high-quality evidence). CONCLUSIONS: The results of the NOAH-AFNET 6 and ARTESiA trials are consistent with each other. Meta-analysis of these 2 large randomized trials provides high-quality evidence that oral anticoagulation with edoxaban or apixaban reduces the risk of stroke in patients with device-detected atrial fibrillation and increases the risk of major bleeding.
Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study
Authors: Ahamed H. Idris, Elisabete Aramendi Ecenarro, Brian Leroux, Xabier Jaureguibeitia, Betty Y. Yang, Sarah Shaver, Mary P. Chang, Tom Rea, Peter Kudenchuk, Jim Christenson, Christian Vaillancourt, Clifton Callaway, David Salcido, Jonas Carson, Jennifer Blackwood, Henry E. Wang
Journal: Circulation (2023)

BACKGROUND: Few studies have measured ventilation during early cardiopulmonary resuscitation (CPR) before advanced airway placement. Resuscitation guidelines recommend pauses after every 30 chest compressions to deliver ventilations. The effectiveness of bag-valve-mask ventilation delivered during the pause in chest compressions is unknown. We sought to determine: (1) the incidence of lung inflation with bag-valve-mask ventilation during 30:2 CPR; and (2) the association of ventilation with outcomes after out-of-hospital cardiac arrest. METHODS: We studied patients with out-of-hospital cardiac arrest from 6 sites of the Resuscitation Outcomes Consortium CCC study (Trial of Continuous Compressions versus Standard CPR in Patients with Out-of-Hospital Cardiac Arrest). We analyzed patients assigned to the 30:2 CPR arm with ≥2 minutes of thoracic bioimpedance signal recorded with a cardiac defibrillator/monitor. Detectable ventilation waveforms were defined as having a bioimpedance amplitude ≥0.5 Ω (corresponding to ≥250 mL V T ) and a duration ≥1 s. We defined a chest compression pause as a 3- to 15-s break in chest compressions. We compared the incidence of ventilation and outcomes in 2 groups: patients with ventilation waveforms in &lt;50% of pauses (group 1) versus those with waveforms in ≥50% of pauses (group 2). RESULTS: Among 1976 patients, the mean age was 65 years; 66% were male. From the start of chest compressions until advanced airway placement, mean±SD duration of 30:2 CPR was 9.8±4.9 minutes. During this period, we identified 26 861 pauses in chest compressions; 60% of patients had ventilation waveforms in &lt;50% of pauses (group 1, n=1177), and 40% had waveforms in ≥50% of pauses (group 2, n=799). Group 1 had a median of 12 pauses and 2 ventilations per patient versus group 2, which had 12 pauses and 12 ventilations per patient. Group 2 had higher rates of prehospital return of spontaneous circulation (40.7% versus 25.2%; P &lt;0.0001), survival to hospital discharge (13.5% versus 4.1%; P &lt;0.0001), and survival with favorable neurological outcome (10.6% versus 2.4%; P &lt;0.0001). These associations persisted after adjustment for confounders. CONCLUSIONS: In this study, lung inflation occurred infrequently with bag-valve-mask ventilation during 30:2 CPR. Lung inflation in ≥50% of pauses was associated with improved return of spontaneous circulation, survival, and survival with favorable neurological outcome.
Interpreter resources for people who speak Spanish at dermatology residency programme clinics
Authors: Keily Ortega, Vrusha K Shah, Camila Ortiz, Alaina J James
Journal: British Journal of Dermatology (2023)

Many residency programmes have inadequate interpreter services and health information available for patients. This cross-sectional study found that although most programme clinics had interpreter services, many were inapt, and five programme clinics (4.1%) had none. With regard to clinic paperwork, nearly half of the clinics did not have all of the paperwork available in Spanish.
Changes in the epidemiology of atopic dermatitis: putting them into context
Authors: Joy Wan
Journal: British Journal of Dermatology (2023)

Journal Article Accepted manuscript Changes in the epidemiology of atopic dermatitis: putting them into context Get access Joy Wan Joy Wan Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Email:jwan7@jhmi.edu https://orcid.org/0000-0002-0189-0442 Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, ljad443, https://doi.org/10.1093/bjd/ljad443 Published: 11 November 2023 Article history Received: 31 October 2023 Accepted: 10 November 2023 Published: 11 November 2023
Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation
Authors: Jeff S. Healey, Renato D. Lopes, Christopher B. Granger, Marco Alings, Lena Rivard, William F. McIntyre, Dan Atar, David H. Birnie, Giuseppe Boriani, A. John Camm, David Conen, Julia W. Erath, Michael R. Gold, Stefan H. Hohnloser, John Ip, Josef Kautzner, Valentina Kutyifa, Cecilia Linde, Philippe Mabo, Georges Mairesse, Juan Benezet Mazuecos, Jens Cosedis Nielsen, Francois Philippon, Marco Proietti, Christian Sticherling, Jorge A. Wong, David J. Wright, Ignatius G. Zarraga, Shelagh B. Coutts, Andrew Kaplan, Marta Pombo, Felix Ayala-Paredes, Lizhen Xu, Kim Simek, Sandra Nevills, Rajibul Mian, Stuart J. Connolly
Journal: New England Journal of Medicine (2023)

Subclinical atrial fibrillation is short-lasting and asymptomatic and can usually be detected only by long-term continuous monitoring with pacemakers or defibrillators. Subclinical atrial fibrillation is associated with an increased risk of stroke by a factor of 2.5; however, treatment with oral anticoagulation is of uncertain benefit. We conducted a trial involving patients with subclinical atrial fibrillation lasting 6 minutes to 24 hours. Patients were randomly assigned in a double-blind, double-dummy design to receive apixaban at a dose of 5 mg twice daily (2.5 mg twice daily when indicated) or aspirin at a dose of 81 mg daily. The trial medication was discontinued and anticoagulation started if subclinical atrial fibrillation lasting more than 24 hours or clinical atrial fibrillation developed. The primary efficacy outcome, stroke or systemic embolism, was assessed in the intention-to-treat population (all the patients who had undergone randomization); the primary safety outcome, major bleeding, was assessed in the on-treatment population (all the patients who had undergone randomization and received at least one dose of the assigned trial drug, with follow-up censored 5 days after permanent discontinuation of trial medication for any reason). We included 4012 patients with a mean (±SD) age of 76.8±7.6 years and a mean CHA2DS2-VASc score of 3.9±1.1 (scores range from 0 to 9, with higher scores indicating a higher risk of stroke); 36.1% of the patients were women. After a mean follow-up of 3.5±1.8 years, stroke or systemic embolism occurred in 55 patients in the apixaban group (0.78% per patient-year) and in 86 patients in the aspirin group (1.24% per patient-year) (hazard ratio, 0.63; 95% confidence interval [CI], 0.45 to 0.88; P=0.007). In the on-treatment population, the rate of major bleeding was 1.71% per patient-year in the apixaban group and 0.94% per patient-year in the aspirin group (hazard ratio, 1.80; 95% CI, 1.26 to 2.57; P=0.001). Fatal bleeding occurred in 5 patients in the apixaban group and 8 patients in the aspirin group. Among patients with subclinical atrial fibrillation, apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; ARTESIA ClinicalTrials.gov number, NCT01938248.)
Characteristics of ‘super responders’ and ‘super nonresponders’ to first biologic monotherapy for psoriasis: a nested case–control study
Authors: Kayleigh J Mason, Oras A Alabas, Nick Dand, Richard B Warren, Nick J Reynolds, Jonathan N W N Barker, Zenas Z N Yiu, Catherine H Smith, Christopher E M Griffiths, Jonathan Barker, Simon Morrison, Anthony Bewley, Ian Evans, Christopher Griffiths, Shehnaz Ahmed, Brian Kirby, Elise Kleyn, Philip Laws, Philip Hampton, Oras Alabas, Kathleen McElhone, Zenas Yiu, Teena Mackenzie, Tess McPherson, Ruth Murphy, Anthony Ormerod, Shernaz Walton, Nick Reynolds, Catherine Smith, Alexa Shipman, Christina Ye, Olivia Hughes, Richard Warren, Fiona Browne, Ian Evans, Brian Kirby, Linda Lawson, Philip Laws, Teena Mackenzie, Tess McPherson, Ruth Murphy, Caroline Owen, Eleanor Pearson, Josh Richards, Catherine Smith, Richard Warren
Journal: British Journal of Dermatology (2023)

It is unknown why some patients with psoriasis experience long-term effectiveness with their first biologic monotherapy. Our aim was to compare the baseline demographic, disease, genotypic, clinical and lifestyle characteristics of patients with psoriasis registered in the British Association of Dermatologists Biologics and Immunomodulators Register and the aligned Biomarkers and Stratification to Optimise outcomes in Psoriasis study who were designated as ‘super responders’ (SRs), defined as patients on their first biologic with more than 5 years continuous biologic monotherapy, or ‘super nonresponders’ (SNRs), defined as patients on their first biologic who had discontinued at least two biologics in their first year of treatment, to biologic therapy. Female sex, shorter study follow-up, higher Dermatology Life Quality Index, high frequency of adalimumab, less frequency of ustekinumab at registration, and higher number of comorbidities were associated with SNRs compared with SRs.
What Lies beneath the Surface — Treatment of Subclinical Atrial Fibrillation
Authors: Emma Svennberg
Journal: New England Journal of Medicine (2023)

Continuous heart rhythm monitoring with cardiac implantable devices has shown that atrial tachyarrhythmias, termed high-rate episodes (AHREs), occur in approximately one third of device carriers.1,2 AHRE definitions vary across studies, but cutoffs of an intracardiac atrial frequency of at least 180 bpm with a duration of 5 minutes or more is common.1 The terms subclinical atrial fibrillation and AHREs are sometimes used interchangeably, although subclinical atrial fibrillation encompasses asymptomatic atrial fibrillation detected by increasingly prevalent wearable devices.3,4 To ensure accuracy, the confirmation of arrhythmias by means of electrogram or electrocardiogram analysis is recommended.3 The risk of stroke in persons with . . .
Comparison of four histological scoring systems for autoimmune hepatitis to improve diagnostic sensitivity
Authors: Soomin Ahn, Sook-Hyang Jeong, Eun Ju Cho, Kyoungbun Lee, Gilhyang Kim, Haeryoung Kim
Journal: Clinical and Molecular Hepatology (2023)

Background/Aims: The histological criteria in the 1999 and 2008 scoring systems proposed by the International Autoimmune Hepatitis Group (IAIHG) have their inherent limitations in diagnosing autoimmune hepatitis (AIH). In this study, we evaluated the histology components of four scoring systems (1. revised original scoring system [“1999 IAIHG”], 2. simplified scoring system [“2008 IAIHG”], 3. modified histologic criteria [“2017 UCSF”], and 4. a new histologic criteria proposed by the International AIH Pathology Group [“2022 IAHPG”]) in AIH patients.Methods: Medical records and liver biopsies were retrospectively reviewed for 68 patients from two independent medical institutions, diagnosed with AIH based on the 1999 IAIHG system between 2006 and 2016. The histological features were reviewed in detail, and the four histological scoring systems were compared.Results: Out of the 68 patients, 56 (82.4%) patients met the “probable” or “definite” AIH criteria of the 2008 IAIHG system, and the proportion of histologic score 2 (maximum) was 40/68 (58.8%). By applying the 2017 UCSF criteria, the number of histology score 2 increased to 60/68 (88.2%), and “probable” or “definite” AIH cases increased to 61/68 (89.7%). Finally, applying the 2022 IAHPG histology score resulted in the highest number of cases with histologic score 2 (64/68; 94.1%) and with a diagnosis of “probable” or “definite” AIH (62/68; 91.2%).Conclusions: The recently proposed UCSF/IAHPG histological criteria increased the histology score of AIH. Substituting the histology component of the 2008 IAIHG system with the 2022 IAHPG criteria increased the sensitivity for diagnosing AIH (≥“Probable AIH”) from 82.4% to 91.2%.
A Phase 1b Study of Lenvatinib plus Pembrolizumab in Patients with Unresectable Hepatocellular Carcinoma: Extended Analysis of Study 116
Authors: Masatoshi Kudo, Richard S Finn, Masafumi Ikeda, Max W Sung, Ari D Baron, Takuji Okusaka, Masahiro Kobayashi, Hiromitsu Kumada, Shuichi Kaneko, Marc Pracht, Tim Meyer, Satoshi Nagao, Kenichi Saito, Kalgi Mody, Zahra Ramji, Leonid Dubrovsky, Josep M Llovet
Journal: Liver Cancer (2023)

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Lenvatinib (dosing for patients who weigh ≥60 kg was 12 mg/day; for patients who weigh &amp;lt;60 kg, the dose was 8 mg/day) plus pembrolizumab 200 mg once every 3 weeks demonstrated antitumor activity and a manageable safety profile in patients with first-line unresectable hepatocellular carcinoma (uHCC) in the open-label phase 1b Study 116/KEYNOTE-524 (primary analysis data cutoff date: October 31, 2019; median follow-up: 10.6 months). This analysis (updated data cutoff date: March 31, 2021) reports efficacy results from 17 months of additional follow-up time. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; 100 patients with uHCC were included in the primary analysis (median follow-up: 27.6 months). Endpoints included overall survival (OS), investigator-assessed progression-free survival (PFS), objective response rate (ORR), and duration of response (DOR) per modified RECIST. Landmark analyses of OS by the best response at 3 and 9 months were performed. Pembrolizumab antidrug antibodies (ADAs) and concentrations were also measured (cutoff date: August 7, 2020). &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; ORR was 43.0% (95% CI 33.1–53.3%) and median DOR was 17.1 months (95% CI 6.9–19.3 months). Median PFS and OS were 9.3 months (95% CI 7.4–9.8 months) and 20.4 months (95% CI 14.4–25.9 months), respectively. No treatment-emergent ADAs were detected. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Results show a sustained treatment effect with lenvatinib plus pembrolizumab in patients with uHCC in the first-line setting.
Second-Line Treatment after Failure of Immune Checkpoint Inhibitors in Hepatocellular Carcinoma: Tyrosine Kinase Inhibitor, Retrial of Immunotherapy, or Locoregional Therapy?
Authors: Sang Youn Hwang, Sangjune L Lee, Hongqun Liu, Samuel S Lee
Journal: Liver Cancer (2023)

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Immune checkpoint inhibitor (ICI)-based therapy such as atezolizumab plus bevacizumab or durvalumab plus tremelimumab became mainstream first-line systemic treatment in advanced hepatocellular carcinoma (HCC) patients since remarkably superior efficacy of ICI-based therapy compared to tyrosine kinase inhibitors (TKIs) was reported in two recent randomized controlled trials (RCTs) (IMbrave150, HIMALAYA). However, the optimal second-line therapy after treatment failure of first-line ICI-based therapy remains unknown as no RCT has examined this issue. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; Therefore, at present, most clinicians are empirically treating patients with TKIs or retrial of ICI or locoregional treatment (LRT) modality such as transarterial therapy, radiofrequency ablation, and radiation therapy in this clinical setting without solid evidence. In this review, we will discuss current optimal strategies for second-line treatment after the failure of first-line ICI-based therapy by reviewing published studies and ongoing prospective trials. &lt;b&gt;&lt;i&gt;Key Messages:&lt;/i&gt;&lt;/b&gt; Clinicians should consider carefully whether to treat the patients with TKI, other ICI-based therapy, or LRT in this situation by considering several factors including liver function reserve, performance status, adverse events of previous therapy, and presence of lesion that can consider LRT such as oligoprogression and vascular invasion. In the meantime, we await the results of ongoing prospective trials to elucidate the best management options.